It has been shown that patients with a history of three or more bursts of oral steroids for asthma exacerbations are at increased risk of future exacerbation. In the United States, national guidelines recommend assessing oral corticosteroid use as a marker of asthma severity and control. The history of asthma exacerbations is an important component of the risk domain of asthma control, which weighs heavily in treatment decisions. However, to date, determining the number of bursts of oral steroids has been difficult and is often inaccurate.
Most physicians, including allergists, assess the frequency of prior asthma exacerbations by taking a history from the patient of the number of times the patient has taken OCS (oral corticosteroid) bursts. Patient history, however, has been found to miss as many as 58% of patients who have had three or more exacerbations in the past year. Pharmacy refill records can also be used to determine whether patients had three or more bursts of oral steroids and are believed to be more accurate. However, few physicians use computerized data from pharmacies to determine the number of OCS bursts used for asthma exacerbations.
Pharmacy data should be considered as part of the clinical assessment of patients with difficult-to-treat asthma. Identifying these patients can result in additional interventions that would further reduce the patent's risk of further exacerbations. Therefore, an improved means to determine and use pharmacy data on the use of oral medication, such as steroids, is needed.
In addition to the foregoing, a need exists for monitoring and control of the dispensation of medication.